Kato So, Murray Jean-Christophe, Kwon Brian K, Schroeder Gregory D, Vaccaro Alexander R, Fehlings Michael G
*Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; †Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; ‡Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA; §Division of Neurosurgery, Department of Surgery, University of Toronto, ON, Canada; ‖Institute of Medical Science, University of Toronto, Toronto, ON, Canada; ¶McEwen Centre for Regenerative Medicine, UHN, University of Toronto, Toronto, ON, Canada; **Spine Program, University of Toronto, Toronto, ON, Canada; ††McLaughlin Center in Molecular Medicine, University of Toronto, Toronto, ON, Canada; and ‡‡Genetics and Development, Krembil Discovery Tower, Toronto Western Hospital, Toronto, ON, Canada.
J Orthop Trauma. 2017 Sep;31 Suppl 4:S38-S43. doi: 10.1097/BOT.0000000000000946.
Traumatic thoracolumbar burst fractures are one of the most common forms of spinal trauma with the majority occurring at the junctional area where mechanical load is maximal (AOSpine Thoracolumbar Spine Injury Classification System Subtype A3 or A4). Burst fractures entail the involvement of the middle column, and therefore, they are typically associated with bone fragment in the spinal canal, which may cause compression of the spinal cord, conus medullaris, cauda equina, or a combination of these. Fortunately, approximately half of the patients with thoracolumbar burst fractures are neurologically intact due to the wide canal diameter. Recent evidences have revealed that functional outcomes in the long term may be equivalent between operative and nonoperative management for neurologically intact thoracolumbar burst fractures. Nevertheless, consensus has not been met regarding the optimal treatment strategy for those with neurological deficits. The present review article summarizes the contemporary evidences to discuss the role of nonoperative management in the presence of neurological deficits and the optimal timing of decompression surgery for neurological recovery. In summary, although operative management is generally recommended for thoracolumbar fracture with significant neurological deficits, the evidence is weak, and nonoperative management can also be an option for those with solitary radicular symptoms. With regards to timing of operative management, high-quality studies comparing early and delayed intervention are lacking. Extrapolating from the evidence in cervical spine injury leads to an assumption that early intervention would also be beneficial for neurological recovery, but further studies are warranted to answer these questions.
创伤性胸腰椎爆裂骨折是脊柱创伤最常见的形式之一，大多数发生在机械负荷最大的交界区域（AO脊柱胸腰椎损伤分类系统的A3或A4亚型）。爆裂骨折累及中柱，因此通常伴有椎管内骨碎片，这可能导致脊髓、脊髓圆锥、马尾神经受压，或上述情况的组合。幸运的是，由于椎管直径较宽，大约一半的胸腰椎爆裂骨折患者神经功能完好。最近的证据表明，对于神经功能完好的胸腰椎爆裂骨折，手术治疗和非手术治疗的长期功能结局可能相当。然而，对于有神经功能缺损的患者，最佳治疗策略尚未达成共识。本综述文章总结了当代证据，以讨论在存在神经功能缺损时非手术治疗的作用以及减压手术促进神经功能恢复的最佳时机。总之，虽然对于有明显神经功能缺损的胸腰椎骨折通常推荐手术治疗，但证据不足，对于仅有神经根症状的患者，非手术治疗也是一种选择。关于手术治疗的时机，缺乏比较早期和延迟干预的高质量研究。从颈椎损伤的证据推断，早期干预对神经功能恢复也可能有益，但需要进一步研究来回答这些问题。
